European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Prophylactic therapy with combined granisetron and dexamethasone for the prevention of post-operative vomiting in children.
This study was undertaken to compare the efficacy and safety of granisetron, a 5-hydroxytryptamine type 3 receptor antagonist, and dexamethasone and each drug alone for the prevention of post-operative vomiting by children, with no history of motion sickness and/or previous post-operative vomiting, undergoing general inhalational anaesthesia for surgery (inguinal hernia and phimosis). In a randomized, double-blind manner, 150 children, ASA physical status 1, aged 4-10 years, were assigned to receive granisetron 40 mg kg-1, dexamethasone 150 mg kg-1, or granisetron 40 mg kg-1 plus dexamethasone 150 mg kg-1 intravenously immediately after inhalation induction of anaesthesia (n = 50 of each). ⋯ No clinically serious adverse events were observed in any of the groups. In conclusion, prophylactic therapy with combined granisetron and dexamethasone was more effective than was each anti-emetic alone for the prevention of vomiting after paediatric surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ondansetron and tropisetron combined with droperidol for the prevention of emesis in women with a history of post-operative nausea and vomiting.
The anti-emetic efficacy of prophylactic ondansetron and tropisetron in combination with a low dose of droperidol in patients with high probability for post-operative nausea and vomiting undergoing gynaecological laparoscopy was compared. Patients were randomly allocated in a double-blind manner to receive either ondansetron 8 mg (n = 45) or tropisetron 5 mg (n = 43) at the end of surgery. A standardized general anaesthetic technique was used, including droperidol 0.75 mg. ⋯ The onset time for rescue medication was significantly sooner after tropisetron than ondansetron (3 h 18 min vs. 6 h 25 min; P = 0.007). There were no statistically significant differences in efficacy between prophylactic ondansetron and tropisetron combined with droperidol in a high-risk population. However, ondansetron appeared to be more effective in preventing post-operative nausea and vomiting in the early hours after surgery compared with tropisetron.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative evaluation of the prolonged use of the cuffed oropharyngeal airway and the laryngeal mask airway in spontaneously breathing anaesthetized patients.
The cuffed oropharyngeal airway (COPA) was compared with the laryngeal mask airway (LMA) with respect to airway quality and respiratory adverse events in 140 spontaneously breathing patients undergoing procedures of duration more than 1 h. Patients were allocated randomly to receive either a COPA (n = 72) or a LMA (n = 68) for airway management during anaesthesia induced with propofol and maintained with sevoflurane, nitrous oxide and oxygen. Groups were similar when comparing the first-time successful insertion rates (COPA: 94.5%, LMA: 95.6%), but airway manipulations (head tilt, chin lift, jaw thrust) were reported more frequently in the COPA group, 27.8% vs. ⋯ LMA, 10.5 (4.5) mL kg-1. The incidences of intra-operative coughing, gagging, laryngospasm, oxygen desaturation and hypercarbia were similar in both groups. Although both devices are equivalent with respect to the overall respiratory problems during spontaneous breathing anaesthesia of intermediate or prolonged duration, the LMA was associated with fewer airway quality problems, suggesting that it is more efficacious in securing the airway.
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Randomized Controlled Trial Comparative Study Clinical Trial
Induction characteristics of thiopentone/suxamethonium, propofol/alfentanil or halothane alone in children aged 1-3 years.
The aim of this study was to compare the effect of three different induction techniques, with or without neuromuscular block, on tracheal intubation, haemodynamic responses and cardiac rhythm. Ninety children, aged 1-3 years, undergoing day-case adenoidectomy were randomly allocated to three groups: group TS received thiopentone 5 mg kg-1 and suxamethonium 1.5 mg kg-1, group H 5 Vol.% halothane and group PA alfentanil 10 micrograms kg-1 and propofol 3 mg kg-1 for induction of anaesthesia. No anti-cholinergics were used. ⋯ TS). In conclusion, induction of anaesthesia with propofol 3 mg kg-1 and alfentanil 10 micrograms kg-1 without neuromuscular block did not provide acceptable intubating conditions in children 1-3 years, although it preserved arterial pressure better than thiopentone/suxamethonium or halothane. Cardiac dysrhythmias were few regardless of the induction method.
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After an intubating dose of rocuronium satisfactory intubating conditions are achieved before the onset time at the adductor pollicis. We examined the possibility that measurement of the relaxation of the masseter muscle is a more appropriate guide when determining the intubating time. Simultaneous accelerometry with a 0.1-Hz single twitch stimulation of the chin and thumb was performed in 20 patients after 0.6 mg kg-1 rocuronium. ⋯ The corresponding mean relaxation at the onset time was also significantly more pronounced at the masseter muscle (99.6 vs. 97.6%). A mean onset time at the masseter muscle of 61 s as produced by rocuronium corresponds clinically with excellent or good intubating conditions. From these results, we suggest that measurement of the onset time of muscle relaxation at the masseter muscle appears to be a better predictor of good intubating conditions than measurements made using the adductor pollicis muscle after administration of rocuronium.